Abstract：
BACKGROUND: Perforated marginal ulcers (PMUs) are a rare but known complication of bariatric surgery. Management typically involves prompt surgical intervention, but limited data exists on non-operative approaches. This study reviews published data on non-operative management of PMUs and presents a case series of patients who were managed non-operatively. Our hypothesis is that certain patients with signs of perforation can be successfully managed non-operatively with close observation.
METHODS: We completed a systematic review searching PubMed, Embase, Web of Science, Cochrane, and clinicaltrials.gov. Ultimately 3 studies described the presentation and non-operative management of 5 patients. Additionally, we prospectively collected data from our institution on all patients who presented between Dec. 2022 and Dec. 2023 with PMUs confirmed on imaging and managed non-operatively.
RESULTS: In our literature review, three patients had Roux-en-Y gastric bypass (RYGB), while two had one anastomosis gastric bypass. One patient required surgery two days after admission. Another underwent elective conversion surgery weeks later for a non-healing ulcer. Two received endoscopic interventions. One patient recovered with nil-per-os (NPO) status, and intravenous proton pump inhibitor (PPI) treatment. The patients in our case series presented with normal vital signs, an average of 30 months after RYGB, and with CT scan signs of perforation. None of these patients required surgical or endoscopic intervention.
CONCLUSIONS: In conclusion, while perforated marginal ulcers have traditionally been considered a surgical emergency, some patients can be successfully treated with non-operative management. More research is needed to identify the clinical presentation features, comorbidities, and imaging findings of this group.
METHODS: We completed a systematic review searching PubMed, Embase, Web of Science, Cochrane, and clinicaltrials.gov. Ultimately 3 studies described the presentation and non-operative management of 5 patients. Additionally, we prospectively collected data from our institution on all patients who presented between Dec. 2022 and Dec. 2023 with PMUs confirmed on imaging and managed non-operatively.
RESULTS: In our literature review, three patients had Roux-en-Y gastric bypass (RYGB), while two had one anastomosis gastric bypass. One patient required surgery two days after admission. Another underwent elective conversion surgery weeks later for a non-healing ulcer. Two received endoscopic interventions. One patient recovered with nil-per-os (NPO) status, and intravenous proton pump inhibitor (PPI) treatment. The patients in our case series presented with normal vital signs, an average of 30 months after RYGB, and with CT scan signs of perforation. None of these patients required surgical or endoscopic intervention.
CONCLUSIONS: In conclusion, while perforated marginal ulcers have traditionally been considered a surgical emergency, some patients can be successfully treated with non-operative management. More research is needed to identify the clinical presentation features, comorbidities, and imaging findings of this group.
摘要：
背景：穿孔性边缘溃疡（PMUs）是一种罕见但已知的减肥手术并发症。管理通常包括及时的手术干预，但是关于非手术方法的数据有限。这项研究回顾了有关PMU非手术管理的已发表数据，并介绍了一系列非手术管理的患者。我们的假设是，通过密切观察，某些有穿孔迹象的患者可以非手术治疗成功。
方法：我们完成了对PubMed，Embase,WebofScience,科克伦,和临床试验。最终3项研究描述了5例患者的表现和非手术治疗。此外,我们前瞻性地从我们的机构收集了12月之间所有患者的数据2022年和12月2023年，PMUs在影像学上确认并非手术管理。
结果：在我们的文献综述中，三名患者接受了Roux-en-Y胃旁路术（RYGB），两个人做了一次胃旁路吻合术。一名患者入院后两天需要手术。几周后，另一位因溃疡未愈合而接受了选择性转换手术。两个人接受了内窥镜干预。一名患者康复，无操作系统(NPO)状态，和静脉质子泵抑制剂（PPI）治疗。我们病例系列中的患者生命体征正常,RYGB后平均30个月，CT扫描有穿孔迹象.这些患者均不需要手术或内窥镜干预。
结论：结论：虽然穿孔的边缘溃疡传统上被认为是外科急症，一些患者可以通过非手术治疗成功治疗。需要更多的研究来确定临床表现特征，合并症,和该组的影像学发现。
方法：我们完成了对PubMed，Embase,WebofScience,科克伦,和临床试验。最终3项研究描述了5例患者的表现和非手术治疗。此外,我们前瞻性地从我们的机构收集了12月之间所有患者的数据2022年和12月2023年，PMUs在影像学上确认并非手术管理。
结果：在我们的文献综述中，三名患者接受了Roux-en-Y胃旁路术（RYGB），两个人做了一次胃旁路吻合术。一名患者入院后两天需要手术。几周后，另一位因溃疡未愈合而接受了选择性转换手术。两个人接受了内窥镜干预。一名患者康复，无操作系统(NPO)状态，和静脉质子泵抑制剂（PPI）治疗。我们病例系列中的患者生命体征正常,RYGB后平均30个月，CT扫描有穿孔迹象.这些患者均不需要手术或内窥镜干预。
结论：结论：虽然穿孔的边缘溃疡传统上被认为是外科急症，一些患者可以通过非手术治疗成功治疗。需要更多的研究来确定临床表现特征，合并症,和该组的影像学发现。
